Truncal obesity (that spare tire you're carrying around) not only looks bad but it can decrease your life span. Adults with high amounts of abdominal fat often develop impaired regulation of their blood sugar. Blood pressure is often increased in obese patients. The condition of obesity, hypertension, and elevated blood glucose is known as the metabolic syndrome. Over time, this will lead to diabetes which causes microscopic damage in the eyes, nerve endings, and kidneys. Eventually this will affect the organs on the end of each of these structures leading to blindness, nerve damage, skin changes, renal failure, and eventually heart disease. As the large blood vessels become more affected the process becomes less and less reversible. Physicians expect an upcoming epidemic of diabetes because of the dramatic prevalence of obesity in the U.S.
Even scarier is the epidemic of obesity in children. Recent statements from the American academy of pediatrics have estimated that the metabolic syndrome is being seen more and more commonly in children and adolescents. As they become obese adults there will be more diabetes, more hypertension and more hyperlipidemia for the health care system to deal with. I recently had to perform a complex procedure on a 39 year old man with the most severe atherosclerosis I have ever seen. This patient wasn’t even a smoker. I can’t imagine the possibilities in the future if subtle tobacco advertising is successful. There have been recommendations to screen adolescents at a younger age for elevated cholesterol and to consider treatment with statins. I suspect that an ounce of prevention with healthy lifestyle choices will be more effective in the future than the mass distribution of Lipitor at the school cafeteria.
Being obese not only is bad for your vascular health but it makes my job even harder. Now we are seeing patients so massively obese that we can’t even perform an angioplasty on them. In our cath lab the weight limit is an astounding 375 lbs. Unfortunately that is not enough in some communities. In fact, our newest angio suite will hold a patient up to 475 lbs. When an obese patient needs a procedure we have to adjust our access point and often have to use the artery in the arm instead of the leg which can add some complexity to the procedure. If we use the leg in an obese patient there is often higher risk of infection and bleeding.
In many cases of obesity, bariatric surgery is very effective at reducing the weight and various metabolic co-morbidities. In fact, now there is some data confirming that weight loss surgery can reduce the risk of cardiovascular disease in obese patients. Don’t think that surgery is the easy way out. Currently patients must undergo very extensive medical and psychological testing before surgery. The surgery is not risk free and the lung and cardiovascular problems that many people are trying to escape often increase their risk for an adverse event. The first step should be to increase activity and decrease caloric intake. Regular exercise will improve some of the metabolic problems associated with obesity but often aren’t enough. Ask your doctor for more information and use the resources available on Livestrong.com.
